PRP offers hope, but clarity is needed

July 29, 2017

Terrence Keaney, MD: “One of the things that is intriguing about PRP is the scientific rationale and mechanism of action. Growth factors found in platelets can be biologically active and effective for a variety of dermatologic conditions.”

New medical treatments offer great promise, but they often fail to live up to the expectations. One of the newest treatments attracting attention in dermatology is platelet-rich plasma (PRP), which was reviewed Friday during the Plenary session.

“I don’t think it’s just hype, but there is still a lot of hope involved with it,” said Terrence Keaney, MD, who presented “Platelet-Rich Plasma: Hype or Hope?” “The FDA has approved it as a device, but the level of evidence is variable. There is a lot of variation in clinical study design, though most studies suggest a clinical effect. Despite its promise, there are still a lot of question marks.”

PRP has been approved for use in orthopedic indications, such as bone grafts, but it is not approved for any dermatologic indications, Dr. Keaney said in an interview about his presentation. However, PRP is being used off-label to treat androgenic alopecia and chronic wounds, and for skin rejuvenation. Dr. Keaney is an assistant clinical professor of dermatology at George Washington University and the founder and director of SkinDC, Arlington, Virginia.

“What is PRP delivering? Platelets not only form clots, but they release a wide variety of growth factors that stimulate multiple organ systems after tissue injury, bone fracture, cartilage damage, and skin injury,” he said. “That is why there has been a lot of hype around PRP, because of the wide range of potential applications. Unfortunately, when physicians hear about a treatment that can potentially have a variety of different uses, the natural reaction is skepticism, a modern-day snake oil.”

Potential uses

PRP is attracting the most attention in dermatology for its use in androgenic alopecia. Many studies have looked at the effect of PRP with positive results, but there is great variety in the designs of those studies, Dr. Keaney said.

“The studies have varied widely in terms of a clinical endpoint,” he said. “How they measured hair loss improvement varied. The system and concentration of PRP delivered varied. The frequency of treatment varied.”

Other differences were the type of delivery system and the number of treatments performed. Some studies used activated PRP, and others did not.

“PRP activation involves adding a substance that causes the platelets to release growth factors prior to injection,” Dr. Keaney said. “Another variable is the ‘PRP dose.’ We are concentrating platelets for them to release their growth factors in the desired area. If you consider PRP the drug, the concentration of platelets in the PRP solution is the dose. It is unclear what the ideal PRP dosing is.”

A second possible application for PRP is skin rejuvenation. Celebrities have promoted the use of PRP as a possible way to increase collagen production.

“There is data to suggest that some of the growth factors found in PRP can upregulate fibroblasts, which could increase collagen synthesis,” Dr. Keaney said. “However, the clinical data is less robust than that of hair loss.”

The third area of use for dermatologists could be the treatment of chronic wounds, especially diabetic foot ulcers. As with hair loss, there are several studies, but they are small randomized studies. It is unclear whether PRP helps with other types of chronic wounds.

A strong safety profile

Despite all of the variables in PRP studies, a common thread is its safety profile, which is excellent when PRP is used appropriately, he said. PRP is an autologous product that, if handled safely, can be delivered with minimal injection-site discomfort.

“As physicians, we have a lot of healthy skepticism because you hear about all of these new treatments that are based on little clinical data,” Dr. Keaney said. “One of the things that is intriguing about PRP is the scientific rationale and mechanism of action that growth factors found in platelets can be biologically active and effective for a variety of dermatologic conditions.

“Unfortunately, because it is a device, there are not going to be a lot of big pharmaceutical companies funding large double-blinded studies. So, it is up to my colleagues and the audience to address and design clever studies to answer these questions because it is worth our time as dermatologists to figure out how PRP fits in our therapeutic armamentarium, and if so, what is the best way to deliver it.”

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